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If no sperm at all can be found in the male ejaculate several times, there is a chance of retrieving sperm cells through a testicular or epididymal puncture. These procedures are carried out at the Kinderwunsch Insitut Dr Loimer by a urologist on a routine basis, as an outpatient with light sedoanalgesia.

MESA stands for ‘microsurgical epididymal sperm aspiration’ and is the attempt to obtain sperm from the epididymis. The sperm duct is located, and an attempt is made to find an obstruction. If an obstruction cannot be removed surgically, semen is punctured from under the epididymis. This can be frozen in liquid nitrogen and used in later fertility treatments.

TESE stands for ‘testicular sperm extraction’. This method is used when the male testicles are not producing semen. During the TESE operation, tissue is removed from the testicle and checked to see whether it contains sperm cells or their precursors. In this case, too, material can be stored in liquid nitrogen at -196 degrees Celsius.

We find that testicular punctures are being performed in facilities where there is no possibility of freezing the recovered material. In the event of artificial insemination, patients are then forced to undergo a second MESA or TESE procedure. At the Kinderwunsch Institut Dr Loimer in Linz, we have the option to store extracted MESA/TESE material in liquid nitrogen for a period of up to 10 years.

Sufficient semen material for artificial insemination can be obtained in at least 75 per cent of patients undergoing a testicular puncture. However, the quality of the semen is not sufficient for fertilisation in the ‘normal way’ or using IUI.